Vol 9, No 2 (2016)

Articles
The comparison of tunnel corneal incision performed with femtosecond laser and keratome
Takhtaev Y.V., Nizametdinova Y.S., Shukhaev S.V.
Abstract
Purpose. To compare and evaluate three-plane clear cornea incision (CCI) created with a femtosecond laser (Victus, B&L) and a metal keratome (2,2 mm steel). Materials and Mehtods. Sixty eyes of 60 patients were examined using anterior segment optical coherence tomography (AS-OCT) in early postoperative period (1 day, 1 week, 1 month) after phacoemulsification surgery. Images were used to measure incision length and incidence of epithelial or endothelial gaping, Descemet membrane detachment. Results. In the femtosecond group (34 eyes) the mean CCI length was 2.02 ± 0.05 mm versus keratome group (26 eyes) 2.04 ± 0.43mm. In laser group all incisions (100 %) were three-plane. In keratome group with manual incisions only 23 % were three-plane, 57.7 % were two-plane and 19.3 % were one-plane. Comparison of morphological features of femtosecond and keratome group: endothelial gaping 20.5 % versus 23 %, epithelial gaping 8.8 % versus 19 %. Descemet membrane detachment 17.6 % versus 34 %, respectively. Conclusion. All eyes in femtosecond group had three-plane profile visible on AS-OCT. Femtosecond CCIs showed better tunnel morphology compared to keratome group. Multiplane profile and minimal damaging of CCI will improve safety in the postoperative period.
Ophthalmology journal. 2016;9(2):5-13
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About endonasal laser dacryocystorhinostomy unfavorable outcomes
Beldovskaya N.Y., Karpishchenko S.A., Kulikova O.A., Baranskaya S.V.
Abstract
Dacryocystorhinostomy (DCRS) performed with a variety of surgical approaches is the most common surgical procedure aimed at restoring the tear outflow. However, regardless of the chosen method, surgery sometimes provides only temporary effect and requires re-intervention (revision). This article presents the analysis of clinical observation of a case series including 76 patients with lacrimal outflow impairment who, in 2014-2015, underwent endonasal endoscopic laser DCRS at the Otorhinolaryngology Department of the First Pavlov State Medical University of St. Petersburg. Among these, re-operation to restore the lacrimal passage was required necessary in 19.7% of cases. The authors concluded that the most frequent reasons of DCRS insufficiency are intractable individual anatomical features of nasal structures and/or lacrimal apparatus of the patients (including atypical anatomy of the lacrimal sac and nasolacrimal duct) and high regeneration ability of the nasal cavity mucous membrane. The probability of re-stenosis increases with previously performed DCRS with unstable result in the patient’s history, concomitant somatic general diseases (diabetes, arterial hypertension, etc.). These reasons may be successfully overcome when choosing an endoscopic approach with laser technology.
Ophthalmology journal. 2016;9(2):14-18
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Trehalose efficacy in dry eye syndrome therapy in diabetic patients
Grigorieva N.N., Peich M.E., Shadrichev F.E.
Abstract
The prevalence of diabetes mellitus with ocular involvement and that of dry eye syndrome constantly increase. As the result, the ophthalmologist has to deal more and more often with patients having signs of both pathological processes. Neuropathy, against the background of metabolic disorders in diabetes, is an additional factor promoting the aggravation of corneoconjunctival xerosis. A significant part of socially active population suffering from carbohydrate metabolism disorder needs a prescription of medications to correct symptoms as well as signs of the dry eye syndrome. The present article concentrates on investigating trehalose efficacy in dry eye syndrome treatment in diabetic patients.
Ophthalmology journal. 2016;9(2):19-26
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The use of diod laser in microphotocoagulation and high density photocoagulation regimens in the treatment of diabetic macular edema
Izmaylov A.S., Kotsur T.V.
Abstract
The modern standard of treatment of clinically significant diabetic macular edema is macular laser photocoagulation was suggested in the reports of the Early Treatment of Diabetic Retinopathy Study (ETDRS, 1985-1990). Subthreshold microphotocoagulation (MicroPulase) leads to developing barely visible or invisible retinal burns and also has been shown to be effective in treating macular edema with no side effects comparing with ETDRS methodic (retinal pigment and choroidal atrophy, decreasing of retinal sensitivity). Effectiveness of microphotocoagulation may arise in high density laser applications, however in modern literature exists rare publications concerning this question.
Ophthalmology journal. 2016;9(2):27-29
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Economic analysis of aflibercept in wet age-related macular degeneration
Gerasimova K.V., Derkach E.V., Loskutov I.A.
Abstract
Objective. The aim of the study was to conduct clinical economic analysis of aflibercept (AFL) treatment compared to that of ranibizumab (RBZ) in patients with wet age-related macular degeneration (wAMD) in the Russian Federation Healthcare healthcare conditions. Materials and methods. Costs calculation was performed by means of simulation with a decision tree constructionmodel. The model was based on the results of clinical studies trials comparing the effectiveness efficacy of AFL and RBZ in patients with wAMD. Time horizon of the model was two years. Costs for the use of each drug in the model were calculated as the average of all possible states weighted according to their probability. Only direct medical costs were taken into account in this studyconsidered. These included costs of the drug, injection procedure, monthly treatment effect monitoring with in case of RBZ treatment, and laser photocoagulation therapy in case of angiogenesis inhibitors’ failure, as well as the costs associated with death. Probabilistic sensitivity analysis was conducted. Results. Total costs for 2 years of AFL therapy were less than with of RBZ: 626.077.12579 543,88 and 697 .264.,12 rubles per patient, respectively. Savings for 2 years favoring AFL equal were 71.187.00117 720,25 rubles per patient. The main factor determiningdriver of the results of in the baseline scenariobase case was fewer AFL injections number compared to RBZ during 2 years of treatment. Results were stable during sensitivity analysis. Conclusion. In the conditions of Russian Federation Healthcare, AFL has an economic advantage over RBZ in patients with wAMD and is the dominant alternative.
Ophthalmology journal. 2016;9(2):30-35
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Laser flare photometry in clinical practice
Astakhov Y.S., Kuznetcova T.I.
Abstract
Laser flare photometry (LFP) is the only quantitative and objective method for the evaluation of aqueous flare. There are numerous opportunities to use LFP in clinical practice, and they are discussed in the paper. It is especially helpful in management of uveitis patients, because it allows estimating the correct diagnosis, managing the patient during the treatment with noninvasive method and predicting relapses and complications.
Ophthalmology journal. 2016;9(2):36-44
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Congenital capsular and zonular abnormalities
Grabobetskiy V.R., Titarenko A.I., Papayan S.S.
Abstract
This article contains a review of the literature on the issue of congenital ectopia of the lens. Two clinical cases of different surgical cataract managements of hereditary subluxated lens were described. Despite of the similar clinical manifestations different surgical approaches were used. The type of surgery was determined with the severity of dystrophic zonules changes and microspherophakia. In both cases the improvement of visual function was achieved.
Ophthalmology journal. 2016;9(2):45-51
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Our experience of bromfenac-containing NSAID use in patients after cataract surgery
Pirogov Y.I., Butina G.M., Morozov R.A., Oksentyuk A.A., Rybina M.V., Chshieva M.R., Shatalov M.S.
Abstract
Postoperative cystoid macular edema is an autoimmune reaction due to the blood-retinal barrier breakdown occurring at anterior segment inflammation. Aim: To analyze the effectiveness of various anti-inflammatory therapeutic schemes used in cataract surgery. Materials and methods. Phacoemulsification using similar consumables had been performed in 792 patients (932 eyes). They were divided into three groups: 1st group included patients receiving 1 to 3 dexamethasone (0.3 ml) and mesatone (0.1 ml) injections and Tobradex eye drops starting with 5 times a day for 4-5 weeks and then tapering (356 eyes); 2nd group (331 eyes) used eye drops of levofloxacin 0.5% solution and dexamethasone; and the 3rd group (325 eyes) in which instillations of ofloxacine and dexamethasone were combined with 0.09% eye drops solution of bromfenac (Broxinac) eye drops, the latter being prescribed QD for 2 days before and 16 days after surgery. Results. Treatment outcomes were less favorable in Group 1 (complications found in 15.2% of patients). Perioperative antibiotic eye drops of 0.5% levofloxacin solution provide a high level prevention of bacterial infection prevention after phacoemulsification. Patients treated with a combination of dexamethasone 0.1% solution eye drops and non-steroidal drug Broxinac had the lowest rate of postoperative inflammatory complications (7.0%).
Ophthalmology journal. 2016;9(2):53-56
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Taflotan, the first preservative-free prostaglandin F2α analogue: treatment advantages in primary open-angle glaucoma patients
Astakhov S.Y., Tkachenko N.V.
Abstract
Over the past 15 years, the negative role of toxic preservatives in the IOP-lowering eye drops solutions used in the treatment of primary open angle glaucoma (POAG) patients has been convincingly proven by many national and foreign experts. Therefore, there is a worldwide tendency to prescribe preferably preservative-free IOP-lowering eye drops nowadays. Taflotan is the world’s first preservative-free prostaglandin F2a analogue. In our study of POAG patients switched to Taflotan from the benzalkonium chloride-preserved latanoprost eye drops, we observed a marked decrease in corneal staining and severity of conjunctival hyperemia, as well as increase of the tear breakup time and corneal epithelium morphology improvement evaluated by confocal tomography. Thus, the drug not only effectively lowers IOP but also produces less negative effect on the tear film and eyeball surface, improving treatment tolerability.
Ophthalmology journal. 2016;9(2):59-68
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Fixed combination bimatoprost-timolol in prevention of ocular hypertension after phacoemulsification of uncomplicated cataract
Alekseev I.B., Khatsukova B.N., Soshina M.M., Samokhina N.I., Nam J.A., Aliverdieva M.A.
Abstract
To date, cataract surgery development aims at minimizing surgical trauma in order to achieve a quicker rehabilitation. However, one of the severe complications of cataract surgery is increased intraocular pressure due to the inflammatory response, the so-called reactive syndrome that occurs in the early postoperative period. Aim of the study was to evaluate the efficacy of a fixed combination of bimatoprost and timolol (Ganfort) eye drops in prevention of ocular hypertension and corneal edema after ultrasonic phacoemulsification. Materials and methods. The study included 60 patients (60 eyes) with uncomplicated cataracts of varying maturity degree. All patients were divided into 2 groups. Patients in the main group (30 patients, 30 eyes, 20 female and 10 male) underwent pneumotonometry before surgery and received a single instillation of Ganfort, and pneumotonometry was performed again 30 minutes after instillation (before surgery), and then again after surgery. Patients in the control group (30 patients, 30 eyes, 19 female and 11 male) underwent pnemotonometry before and after surgery. Results. The postoperative period was similar in both groups. On the first day after surgery, mean intraocular pressure in patients of the main group was 12.9 mmHg while in the control group the mean intraocular pressure was 20.1 mmHg. In patients of the main group, intraocular pressure decreased by 1/3 with Ganfort therapy on the first day after surgery, and biomicroscopic corneal findings were less pronounced in the main group compared to the control group. Conclusion. The results of our study show that even uncomplicated cataract phacoemulsification with IOL implantation leads to a reactive postoperative increase of intraocular pressure from 17.5 to 20.1 mmHg. In our study, the use of Ganfort did not cause side effects or intolerability. Ganfort use may be considered as an effective prophylactics of ocular hypertension and corneal edema after ultrasonic phacoemulsification.
Ophthalmology journal. 2016;9(2):69-73
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To the endogenous uveitis classification
Ustinova E.I.
Abstract
Endogenous uveitis classification importance is obvious due to the large variety of etiological factors and pathogenesis and treatment complexities. Most proposed classifications are based on the description of signs offered in the form of plain text, and available individual schemes do not cover all necessary issues. The recommended classification scheme of endogenous uveitis consists of five sections: etiology, clinical type (pathogenesis), localization, clinical course and the phase of activity. In contrast to the classifications proposed by other authors it is supplemented by the etiologic (additional scheme) and pathogenetic (clinical pathogenic type) parts. Classification allows the clinical diagnosis to reflect the process history taking into account the pathogenic and clinical types of the disease (granulomatous or focal, and nongranulomatous or toxico-allergical uveitis) and to determine the rational therapy.
Ophthalmology journal. 2016;9(2):74-80
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Ophthalmic manifestation of leukemia
Chistyakova N.V.
Abstract
This paper includes a literature review on the ophthalmic manifestations of leukemia. Various eye disorder types in leukemia with concurrent anemia, hypoxia, increased blood viscosity, as well as the compression of tissues by tumor cells conglomerates and/or presence of direct leukemic infiltration were considered. Ophthalmic diseases in patients with hematological malignancies may occur due to opportunistic infections and the impact of such treatments as chemotherapy, radiotherapy and bone marrow transplantation. Reliable estimation of eye involvement rates in leukemic process is difficult, as many patients are asymptomatic at early stages of the disease. However, the predictive value of visual impairment assessment in leukemia is high, which requires close cooperation between ophthalmologists and hematologists, and appropriate adjustment of both local and systemic therapies.
Ophthalmology journal. 2016;9(2):81-99
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Primary choroidal lymphoma
Potemkin V.V., Astakhov Y.S., Marchenko O.A., Vinogradova Y.N., Raskin G.A., Ageeva E.V.
Abstract
The case of primary choroidal lymphoma was submitted. We described specific features that require the exception of choroidal lymphoma.
Ophthalmology journal. 2016;9(2):100-105
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Functional rehabilitation of the patient with keratoconus after collagen cross-linking with modified parameters
Papayan S.S., Riks I.A., Novikov S.A.
Abstract
This article contains a clinical case of a favorable outcome of treatment of chronic keratoconus by the collagen cross-linking with modified parameters. Possible mechanisms of action of collagen cross-linking on biomechanical and biochemical properties of the cornea are presented as well as survey data and postoperative dynamic monitoring of the patient before and after collagen cross-linking. Reasoning about new ways to perfect standard approaches with the aim of improving the results of the application of this treatment are also given.
Ophthalmology journal. 2016;9(2):106-111
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